摘要
目的探讨总结严重多发伤救治中,多巴胺、酚妥拉明等血管活性药的治疗疗效及临床意义。方法对ISS≥17分的严重多发伤,有心肺功能不全或ARDS、ALI,或CVP>8 cmH2O、SBP(收缩压)>90 mm Hg,有微循环灌注不良,年龄大,原有慢性心肺病患并发肺部感染者,予以小剂量多巴胺、多巴酚丁胺及酚妥拉明微量泵持续泵入,同时监测CVP、呼吸、心率及动脉血气等。结果多发伤后早期急性心肺功能不全的检出率分别达42.3%及51.9%;血管活性药可改善胸闷、气短等临床症状,减慢过快呼吸、心跳,提高PaO2及SaO2,有效率达93.0%。结论严重创伤导致过度应激反应,以外周血管收缩为伤后儿茶酚胺释放的主要特征,小剂量多巴胺及酚妥拉明类血管活性药,可增强创伤后不同基础患者心肺功能,改善预后。
Objective To investigate the clinical value of vasoactive agents （dopamlne, phentolamine ） on the patients with severe multiple trauma. Methods With the monitoring of central venous pressure（CVP） , respiration, heart rate and blood gas analysis, patients with ISS ≥ 17 after severe multiple trauma, cardiopulmonary dysfunction, ARDS, acute lung injury or CVP 〉8 cm H2O（5.8 mm Hg） , systolic blood pressure （ SBP ） 〉 90 mm Hg, microcirculatory impairment, older, chronic cardiac and pulmonary disease, pulmonary inflammation were continuously treated with low close of dopamine, dohutamine and phentolamine. Results The incidence rate of cardiopulmonary dysfunction were 51.9% ,42. 3% at an early stage after multiple trauma. Low close of vasodilator and cardiotonic could alleviate the symptom of chest distress and short breath, slow faster respiration, heart rate, and improve PaO2 and SaO2. The effective rate was 93%. Conclusion Severe multiple trauma resulted in systemic inflammatory response syndrome （ SIRS ） , The characteristics of catecholamine release was peripheral vascular contraction. Low dose of vasoactive agents like dopamine, phentolamine could ameliorate cardiopulmonary function after trauma, and improve the prognosis.
出处
《中国急救医学》
CAS
CSCD
北大核心
2008年第4期356-358,共3页
Chinese Journal of Critical Care Medicine
关键词
多发创伤
血管活性药
多器官功能障碍综合征
Multiple trauma
Vasoactive agents
Multiple organ dysfunction syndrome
